David Aitchison's bright yellow bike is still chained to the banister of the stairwell of his flat in south London. His father, Tony, points it out as we go down the stairs and walk around the corner to the hotel where he and his wife, Jenny, are staying. It's the day before their son's funeral. David died just over a week ago, suddenly and in his sleep. He was 29 and a triathlete (the sport that takes in swimming, running and cycling); he was superfit and healthy. "It's one of the ironies that I don't know anybody who was as careful with what they ate to try to make sure it was nutritious, and gave him energy," says Tony. "He was so health-conscious, which makes this all the harder to believe."
David died of cardiomyopathy, a condition that causes the heart muscle to thicken and become enlarged, affecting its ability to pump blood around the body. In many cases, like David's, it can go undiagnosed as there are often no symptoms. There are four types of cardiomyopathy - doctors aren't yet sure which one affected David - and some are thought to be genetic, but little is known about why it happens.
There had never been any hint that David had any heart problems as a child, or when he started training hard - first in his teens, when he was a cross-country runner for his county, and later, when he started competing in triathlons. Even fitness tests he underwent at a university showed no abnormalities. The condition can be congenital, but neither Tony nor Jenny knows of any family history. All they can do now is wait for the test results, which may show that it was an inherited condition, and may mean that one of them, or their daughter, Jane, also has it.
It happened without any warning in the early hours of a midweek morning in late January. "That's the only comfort, really," says Jenny Aitchison. "That he didn't suffer, he wasn't afraid, he wasn't alone." David lived with his girlfriend, Claire-Bridget (known as CB). They went to bed as usual, and CB woke early because her boyfriend's breathing had become loud and strange - what the family now think was his last breath. His heart stopped and she tried to revive him before calling for help. Paramedics soon arrived, but they failed to resuscitate him, then rushed him to the nearby St Thomas's hospital.
"I got a telephone call at work on Wednesday morning from the hospital," says Jenny, who works for a further education college and teaches literacy in homeless hostels. "Tony was in Manchester and although I'd spoken to him, I didn't want to tell him because he'd have to drive home. I didn't believe it." She says she spent the rest of the day just staring out of the window, waiting for her husband to come home to their house in Nottingham. "I knew something strange was going on because when I spoke to Jenny, she just said, 'Come home,' " says Tony. "I walked in and Jenny said, 'It's the worst possible ...' And that was absolutely spot on."
Tony still lapses into the present tense when he talks about his son. "We were so fortunate, that from their tiniest days, Jane and David were best friends. They are still incredibly close - they speak weekly. We just had a wonderful Christmas with everyone together. We look back on blessings, and that's one of them. He was clowning around as usual and making everyone laugh."
David had a determined streak - he was competitive and trained almost daily - but he was also, it seems, incredibly modest. Few of his friends and colleagues knew just how successful an athlete he had become. Last year, he took a bronze medal at the International Triathlon Union world championships, and won many other events: he was named Triathlete of 2006 for his age group. Not bad, considering he only competed in his first triathlon in 2005. He was also enjoying his job at a web-design company. "In the last couple of years, it had all come together," says Tony. This year David was going to the world championships again, and had started training for bigger, harder competitions.
Tony, a keen runner himself, was concerned that his son's training regime might have enlarged his heart, contributing in some way to the cardiomyopathy. There is a condition known as athlete's heart, where rigorous training results in the heart of an athlete expanding, but this isn't cardiomyopathy. Rigorous exercise is not thought to cause cardiomyopathy, but may trigger it in someone with the underlying condition.
Tony and Jenny manage to smile and laugh about their son; about when he started training for the triathlon and his "awful swimming stroke" ("He had to learn to swim all over again," says Jenny); about his practising taking off his wetsuit in the bath to beat his best time; about how, at Christmas, after an operation on his shoulder, he would use his sling to do pirate impressions to amuse his family.
The huge number of messages sent to the website of David's triathlon club by friends and even people he had met once or twice underline his outgoing personality. "You are totally irreplaceable. Your amazing outlook on life, your cheeky grin ... not to mention the oversize belts, the wigs, and of course the dance moves!" writes one friend. Another writes: "He brought joy and sunshine to people's lives, something we should all strive for, but which to him was effortless."
The enduring theme is disbelief that this could have happened. "He was such a positive person," says Jenny. "He taught me a lot. Whatever happened, he would always find the positive, not in a Panglossian way, but simply, 'Don't get too upset about things; accept it has happened, and move on' ".
Cardiomyopathy: What we know - and what we don't
Cardiomyopathy means that the heart muscle is abnormal without an obvious cause. It affects the heart's ability to pump blood. There are four main types: hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy and arrhythmogenic cardiomyopathy.
The heart muscle may thicken because of persistently high blood pressure, which may be undiagnosed or poorly controlled, but in hypertrophic (thickening) cardiomyopathy, the thickening occurs for no obvious reason. It is thought that one in 500 people have hypertrophic cardiomyopathy and it can be inherited. If one parent has it, their children have a 50% chance of inheriting it. It is the biggest medical cause of sudden death in people under 35 and around four young people a week die from it.
In dilated cardiomyopathy, the heart becomes enlarged and weak and can't pump blood as strongly as it should. This can lead to breathlessness and a build-up of fluid in the lungs. Other symptoms include tiredness, and fluid accumulating around the ankles or small of the back. Although an enlarged heart can be caused by high blood pressure or heart disease, there is no known cause, although it is thought that excessive alcohol consumption, viral infections or, in rare cases, chemotherapy treatment for cancer may all contribute. It can also affect women during mid- to late pregnancy or shortly after birth, although in most cases, it resolves itself.
In arrythmogenic cardiomyopathy, some parts of the heart muscle are replaced by fatty tissue. This affects the normal pulse pattern and can result in blackouts, palpitations and tiredness. There is no known cause, but it can be inherited and is usually seen in teenagers or those in their early 20s. Many people can live with it without serious problems.
Restrictive cardiomyopathy is the rarest of the types. The lower chambers of the heart become stiff and restrict blood flow through the heart. There is no cure and the condition has been linked to rare metabolic conditions, and can occur after a patient has had radiotherapy for some cancers.
Treatment varies widely depending on the patient and the type of cardiomyopathy but drugs and surgery can be effective. The Cardiomyopathy Association would like to see more heart screening and genetic testing for families at risk.
· For more information on any type of cardiomyopathy, contact the Cardiomyopathy Association (freephone 0800 018 1024; cardiomyopathy.org)
